医疗保健提供者在支持社区居住的老年慢性病患者管理方面的经验：一项定性研究。
Healthcare providers' experiences in supporting community-living older adults to manage multiple chronic conditions: a qualitative study.
机构信息
School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences and Associate Member, Department of Health, Aging and Society, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Faculty of Nursing, University of Alberta, Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada.
出版信息
BMC Geriatr. 2019 Nov 19;19(1):316. doi: 10.1186/s12877-019-1345-2.
BACKGROUND
Living with multiple chronic conditions (MCC), the coexistence of two or more chronic conditions, is becoming more prevalent as the population ages. Primary care and home care providers play key roles in caring for older adults with MCC such as facilitating complex care decisions, shared decision-making, and access to community health and support services. While there is some research on the perceptions and experiences of these providers in caring for this population, much of this literature is focused specifically on family physicians. Little is known about the experiences of other primary care and home care providers from multiple disciplines who care for this vulnerable group. The purpose of this study was to explore the experiences of primary and home care healthcare providers in supporting the care of older adults with MCC living in the community, and identify ways of improving care delivery and outcomes for this group.
METHODS
The study used an interpretive descriptive design. A total of 42 healthcare providers from two provinces in Canada (Ontario and Alberta) participated in individual semi-structured, face-to-face 60-min interviews. Participants represented diverse disciplines from primary care and home care settings. Inductive thematic analysis was used for data analysis.
RESULTS
The experiences and recommendations of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), supporting caregivers, (4) using a team approach for holistic care delivery, (5) encountering challenges and rewards, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers identified the need for a more comprehensive, integrated system of care to improve the delivery of care and outcomes for older adults with MCC and their family caregivers.
CONCLUSIONS
Study findings suggest that community-based healthcare providers are using many relevant and appropriate strategies to support older adults living with the complexity of MCC, such as implementing person-centred care, supporting caregivers, working collaboratively with other providers, and addressing social determinants of health. However, they also identified the need for a more comprehensive, integrated system of care.
背景
随着人口老龄化，患有多种慢性疾病（MCC）的人数逐渐增多，即同时患有两种或两种以上的慢性疾病。初级保健和家庭护理提供者在照顾患有 MCC 的老年人方面发挥着关键作用，例如促进复杂的护理决策、共同决策以及获得社区卫生和支持服务。尽管有一些关于这些提供者在照顾这一人群时的看法和经验的研究，但其中大部分文献都专门针对家庭医生。关于来自多个学科的其他初级保健和家庭护理提供者照顾这一弱势群体的经验却知之甚少。本研究旨在探讨初级保健和家庭保健医疗保健提供者在支持社区中患有 MCC 的老年人护理方面的经验，并确定改善这一群体护理服务提供和结果的方法。
方法
该研究采用解释性描述设计。来自加拿大两个省（安大略省和艾伯塔省）的 42 名医疗保健提供者参加了个人半结构化、面对面 60 分钟的访谈。参与者代表了初级保健和家庭保健环境中的各种不同学科。使用归纳主题分析进行数据分析。
结果
管理患有 MCC 的老年人护理的医疗保健提供者的经验和建议组织成六个主要主题：（1）管理 MCC 相关的复杂性，（2）实施以患者为中心的护理，（3）支持照顾者，（4）使用团队方法进行整体护理服务，（5）遇到挑战和奖励，（6）建议解决医疗保健系统挑战的方法。医疗保健提供者确定需要建立一个更全面、综合的护理系统，以改善患有 MCC 的老年人及其家庭照顾者的护理服务提供和结果。
结论
研究结果表明，基于社区的医疗保健提供者正在使用许多相关且适当的策略来支持患有 MCC 复杂性的老年人，例如实施以患者为中心的护理、支持照顾者、与其他提供者合作以及解决健康的社会决定因素。然而，他们还确定需要建立一个更全面、综合的护理系统。
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